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ObamaCare Medicaid Expansion

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ObamaCare’s Medicaid Could Insure 21.3 Million Americans in the Next Decade. So Why Did Some States Opt-Out Of Expanding Medicaid?

ObamaCare Medicaid Expansion is one of the biggest milestones in health care reform. ObamaCare’s Medicaid expansion expands Medicaid to our nations poorest in order cover nearly half of uninsured Americans, however a change to the law will leave 5.7 million without coverage by 2016.

Get Covered in Medicaid or CHIP Now

You can sign up for Medicaid and CHIP 365 days a year. You may qualify for free or low-cost care through Medicaid based on income and family size ($16,105 individual $32,913 for a family of four). If you think you are eligible for Medicaid you can sign up for Medicaid now.

Most of these states enacted proposed Medicaid expansion alternatives that don’t always cover all adults, or don’t cover them at the same cost sharing as other states, so know your state’s Medicaid program if they are on the above list.

If your state hasn’t expanded Medicaid yet, let your state reps know you deserve the same access to care they have. Please note that specific facts and figures on this page are sometimes based on data from before these states expanded, the more states that expand, the less Americans go without coverage.

States Opting Out of Medicaid Expansion

The law previously required states to expand coverage to everyone making less than 138% of the Federal Poverty Level (FPL) or lose federal funding to Medicaid, however that provision was changed during a supreme court ruling on ObamaCare.

State’s can now opt-out of Medicaid Expansion leaving millions of poor working families in the “Medicaid coverage gap” between those who qualify for Medicaid (as low as 50% FPL in some states) and those who qualify for marketplace subsides (between 100% – 400% FPL).

States opting out of the expansion of Medicaid under ObamaCare is projected to drive up insurance costs, while saving the States relatively small amounts (with some, like Minnesota, showing up to a billion in new revenue under the program).

The bottom line on Medicaid Expansion: Does the money the states will save by not expanding Medicaid outweigh the costs related to millions going uninsured?

ObamaCare Medicaid Expansion Overview

Let’s take a quick look at ObamaCare’s Medicaid expansion and how it affects American families.

• Medicaid is a joint federal and state funded program that provides health care for over 60 million low income Americans.

• As of 2013 every State had different eligibility requirements for Medicaid based on income, age, gender, dependents, and other specific requirements.

• Some states had/have very narrow eligibility requirements for Medicaid which leaves many working adults uninsured.

• Starting in 2014 state’s that participated in Medicaid expansion increased eligibility levels for everyone in their state to 138% of the Federal Poverty Level (about $16,105 for an individual and $32,913 for a family of four in 2015).

• Even if your state didn’t expand Medicaid you may be eligible for Marketplace subsidies if you make between 100% – 400% FPL.

• States that did not expand have unique eligibility requirements.

• Since every State covers those who have no income, expansion would almost exclusively be covering the working poor and their families.

• Poor working families are the most likely to not have insurance due to affordability, Medicaid expansion helps “cover the gap” between current Medicaid eligibility and families being able to afford private health insurance using marketplace subsidies.

• About half of the uninsured in America would be covered by Medicaid Expansion if all states opt-in.

• Over 15 million men, women and children will be eligible for Medicaid in State’s that participate in Medicaid Expansion.

• 5.7 million people will be uninsured in 2016 because 24 States have not expanded Medicaid.

• Only 54% of potentially eligible adults are aware of Medicaid expansion under the Affordable Care Act.

• Millions of Americans will be able to get care before they are forced to use costly last minute emergency services.

• The uninsured currently cost hospitals billions in unpaid hospitals bills, some of these costs are indirectly passed onto the average taxpayer with insurance.

• Unpaid hospital bills to hospitals are one of the main causes of rising premium costs.

• The Federal Government pays 100% of expansion costs for the first three years and 90% thereafter until 2022.

• Many State’s have shown that Expanding Medicaid actually raises money for the State.

• Cost is the most cited reason for not expanding Medicaid. While current Medicaid programs do costs state taxpayers a lot of money, that spending is balanced by unpaid hospital bills and the affect those bills have on the rising costs of premiums.

• Most State who opt-ed out of expansion (except Vermont and Montana) had a Republican governor when Medicaid expansion was originally rejected.

• Most of the State’s who opt-ed out have the highest uninsured rates and are the State’s expansion would help the most.

• Of course the higher number of uninsured who qualify for Medicaid, the more it costs the state to cover them.

• Some people say state’s opt-ing out of Medicaid expansion is part of an ongoing effort to “break” ObamaCare regardless of the cost to the people. Other tactics include opt-ing out of creating exchanges, expensive disinformation campaigns, a Government shutdown, suing the President, 50 plus repeal attempts, and more.

• States had until January 2014 to decide if they would expand Medicaid. Many states are not moving forward with the program at this time, however they can still decide to expand Medicaid later. For instance PA decided to expand Medicaid in 2014. TE and IN are expanding as of 2015.

Know the Law. The Affordable Care Act contains 10 titles, each title addresses a different aspect of health care reform. Title II – The Role of Public Programs addresses Medicaid expansion. Check out our summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the Affordable Care Act and Medicaid expansion.

History of ObamaCare’s Medicaid Expansion and the NFIB

Unfortunately, when the NFIB took the Affordable Care Act to the supreme court in an attempt repeal it, the Medicaid expansion requirement was overturned leaving millions without access to health insurance.

Since the ruling, each state can decide whether or not they want to opt out of expanding coverage to 138% of the federal poverty level with no penalty to funding. This resulted in many states opting out of expansion and leaving in place their narrow eligibility guidelines.

The new ruling doesn’t just hurt Medicaid and ObamaCare, it affects the tax payer by forcing us to pay for states that choose not to help their poorest. Even though expanding Medicaid would have cost the federal tax payer, states and tax payers are still picking up the tab on those who fall through the “Medicaid gap” as these individuals will either use emergency services or purchase subsidized health insurance through the marketplace using federal tax credits. In other words while it potentially saves the state money, it leaves millions without insurance and still shifts costs federal tax payers.

• National Federation of Independent Business (NFIB) is an “independent” group that represents “small business”. However, they historically follow the Republican party line and fight against “entitlement” programs like ObamaCare’s Medicaid Expansion that help the nations poorest working families and smaller businesses.

• About half of the uninsured are small business owners and employees, many whom would have qualified for coverage under Medicaid expansion had the NFIB not taken the ACA to court.

• Remember the only businesses that pay more under ObamaCare are the top 3% of small businesses and big businesses. Learn More About small business and ObamaCare.

Nearly ONE HALF of uninsured Americans were going to get their health insurance under ObamaCare Medicaid reform by expanding coverage to the nations’ poorest starting in 2014. Now states can opt-out without losing federal funding.

What is Medicaid?

Medicaid is a joint federal and state funded program that provides health care for over 60 million low income Americans, mostly children, pregnant women, people with disabilities and elderly people who need help or live in nursing homes.

Since Medicaid is a program that works partly on a state level with help from the federal government the rules alter from state to state, but the rule of thumb is that most low-income adults under 65 cannot currently receive Medicaid.

What is CHIP Children’s Health Insurance Program?

How is Medicaid Funded?

Medicaid is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). FMAP varies by state based on criteria such as per capita income. Under the Affordable Care Act states that choose to expand have 90% of the costs funded by the federal government helping to ensure states aren’t over burdened by the cost. However, some states who opted out felt that they couldn’t depend upon the federal government to continue paying this percentage and/or even with the funding costs would be too high.

This video explains how medicaid is funded and how the ACA affects Medicaid funding.

Who Qualifies for Medicaid?

Medicaid works differently in every State. The eligibility guidelines for Medicaid are set by the Federal Government and then some State’s choose to expand them. This is how it worked before ObamaCare and due to the Medicaid expansion opt-out it still works this way today.

• To be eligible for coverage, a person must belong to an eligible group (generally: children, pregnant women, parents, blind or disabled persons, and the elderly) and meet the financial eligibility requirements for that group.

• Prior to the ACA, the federal government already mandated that eligibility levels for children and pregnant women be at least 100-133 percent (see table below), but eligibility levels for parents could be much lower, and states were not required to cover adults without dependent children at all.

• As of December 2009, eligibility levels for parents in 17 states were at or below 50 percent FPL (which is $11,725 for a family of four in 2012). Another 17 states set eligibility levels for parents at or below 100 percent FPL (which is $23,550 for a family of four in 2013).

• As of December 2009, only five states allowed adults without dependent children to enroll in Medicaid, although two of those states plus another 14 states offered some limited set of benefits to some childless adult.

• The eligibility requirements of Medicaid leave about 20 million people in the gap between affording insurance and being eligible for Medicaid.

• Children who don’t qualify for Medicaid may qualify for CHIP (Children’s Health Insurance Program) which works closely with Medicaid.

• Medicaid can also help Seniors If you qualify for Medicaid in your state, you automatically qualify for extra help paying your Medicare prescription drug coverage (Part D). Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.

What is Medicaid Expansion?

Medicaid expansion expands Medicaid eligibility to all individuals and families below the 138% Federal Poverty Level. This includes many groups (like single men) those who weren’t previously eligible.

Medicaid Expansion Guidelines

The following guidelines will help you find out if you qualify for Medicaid. These guidelines only apply to states who expanded Medicaid. See additional guidelines below for eligibility levels that apply to states that did not expand Medicaid.

*Medicaid eligibility is different in states that did not expand Medicaid. Federal Poverty Guidelines are different in Hawaii and Alaska.

Who Qualifies for Medicaid Expansion Under ObamaCare?

Eligibility for Medicaid Expansion is decided on state by state. In State’s that do expand Medicaid all legal residents who earn less than $15,302 for individuals and $31,155 for a families of four can receive Medicaid under Medicaid Expansion. In State’s that don’t expand Medicaid, eligibility only includes a very limited cross section of the population and income levels as low as 50% FPL. People covered under the expansion also include:

• Low income adults with or without dependent children

• Low income children who lose their Medicaid benefits when they are reclassified as adults 19 years.

• Low income adults with disabilities who are not eligible for SSID or SSI.

The following table is an example of eligibility levels for different groups by % of Federal Poverty Level (FPL)

Categorical group

U.S. minimum threshold pre-ACA, 2009*

State thresholds, 2009: medians, (ranges)

U.S. minimum thresholds under ACA, 2014**

Children 0-5

133% FPL

235% FPL(133-300% FPL )

133% FPL

Children 6-19

100% FPL

235% FPL(100-300% FPL)

133% FPL (note traditional vs new)

Pregnant women

133% FPL

185% FPL(133-300% FPL)

133% FPL

Working parents

State’s July 1996 AFDC eligibility level^

64% FPL(17-200% FPL)

133% FPL (note traditional vs new)

Non-working parents

State’s July 1996 AFDC eligibility level^

38% FPL
(11-200% FPL)

133% FPL (note traditional vs new)

Childless adults

Eligibility not mandated. State must apply for waiver to cover this group.

0% FPL
(0% FPL in 46 states; 100-160% FPL in 5 states)

133% FPL (note traditional vs new

Elderly, blind, disabled

Receipt of SSI^

75% FPL
(65-133% FPL)

Receipt of SSI

Has Expanding Medicaid Worked Before?

New York, Arizona and Maine expanded Medicaid between 200 and 2005. A Harvard study reports, “rates of uninsured residents dropped, access to care improved, and more people reported being in very good or excellent health”. The coverage was estimated to save a total of 2,840 lives a year for the states.

Why the ObamaCare Medicaid Expansion Matters

Medicaid expansion would provide access to health insurance for almost half of our nations uninsured.

Letting states Opt-out of ObamaCare’s Medicaid expansion not only leaves millions without coverage, it also costs taxpayers money.

Uninsured Americans cost tax-payers money because they use costly emergency services instead of getting the preventative care they need.

In State’s that don’t set up a marketplace or expand Medicaid Federal tax dollars are used to subsidize many who would have been eligible for Medicaid under expansion. Medicaid costs are shared between the State and Federal Government.

Medicaid Expansion 133% or 138%?

Sometimes we say Medicaid is expanded to the 133% and sometimes we say 138%. Both are correct. The text of the ACA says 133%, but the law also calls for a new methodology of calculating income, which will make the effective minimum threshold 138%. (Either way, remember that these are minimum thresholds; states can set eligibility thresholds higher, and many already have for certain populations, which means that more people qualify.)

Currently (prior to the ACA Medicaid expansion), parents in 17 states don’t qualify for Medicaid unless their incomes are below this threshold. (Eligibility levels for children are higher, so in a given family, children may qualify while parents don’t.) In nearly all states, childless adults are ineligible regardless of income.

100%

$11,670

$23,850

This is the official poverty threshold, updated each year by the federal government. It varies by family size and composition.

As written in the ACA, persons with family incomes below this threshold are not eligible for subsidies to purchase insurance in the exchanges. In states that don’t expand Medicaid, individuals with incomes above their state’s current eligibility level, but below 100 percent FPL, will not qualify for anything.

133%

$14,856

$30,675

As written in the ACA, this will be the new minimum eligibility threshold for nearly everyone under 65. However, the effective threshold will actually be 138%. See next line.

138%

$16,105

$32,913

Even though the ACA states that the new threshold is 133%, it will effectively be 138%, because 5% of people’s income will be “disregarded.” See below for more information.

400%

$46,680

$95,400

This will be the upper limit for eligibility for income-based subsidies for the purchase of private insurance through the new health insurance exchanges.

How to Apply for Medicaid

In the past applying for Medicaid meant you needed to meet certain criteria such as being pregnant, having a child or having a disability and usually meeting some sort of income requirement. In State’s that have implemented expansion the only main requirement is that you make less than 133% of the Federal poverty level.

Since the guidelines are so complicated, the easiest way to find out if you are eligible for Medicaid is to fill out an application at your State’s health insurance marketplace. Read our guide to the Health Insurance Exchanges to find out more about using your State’s online marketplace to sign up for insurance. The application process will notify you if you are eligible for Medicaid.

Sign Up for Medicaid Now

Each state has different rules about eligibility and applying for Medicaid. You Can use one of the two following methods to apply for Medicaid:

What is “Wrong” With Medicaid?

ObamaCare opponents use the downfalls of Medicaid as terms to reject Medicaid Expansion. Drawbacks of Medicaid include: limited access to health care, low-end quality healthcare and coverage and low doctor payouts. ObamaCare’s reforms address many of the issues with the quality of Medicaid since it’s provisions increase the quality of care for all types of insurance and it also contains provisions to increase doctor payouts as well!

Doctor payouts have been historically low. Due to low payouts, many doctors don’t take Medicaid and the quality of care tends to be poor. However, ObamaCare’s Medicaid Reforms do a lot to change this.

The ObamaCare Medicaid reforms that come with ObamaCare’s Medicaid Expansion include raising the amount doctors get paid to the same level of Medicare (73%) and increasing payments to Medicaid programs that offer preventive services for free or at little cost. New free preventive services include tests for high blood pressure, diabetes, and high cholesterol; many cancer screenings, including colonoscopies and mammograms; counseling to help people lose weight, quit smoking or reduce alcohol use; routine vaccinations; flu and pneumonia shots; and other services.

ObamaCare Medicare Reforms

Aside from Medicaid expansion itself the Affordable Care Act does a lot to improve Medicaid. You can check out the complete list of reforms here.

ObamaCare Medicaid Expansion Opt-Out: The Medicaid Gap

Since states have the right to opt-out of Medicaid for it’s poorest without losing any federal funding many potentially eligible Americans are left in “the Medicaid gap“. The gap refers to those who don’t qualify for Medicaid and don’t make enough to qualify for marketplace subsides either.

ObamaCare Medicaid reform was meant to cover over 20 million Americans through Medicaid now up to 5.7 million are estimated to go without health insurance due to states rejecting expansion alone.

Expansion Fact: Texas opting out of Medicaid Expansion leaves 1.1 million Texans with no coverage due to the Medicaid coverage gap.

What if All States Moved Forward With Medicaid Expansion?

If all states move forward with ObamaCare’s Medicaid Expansion they will collectively pay $76 billion (a 3% increase) to insure up to 21.3 Million individuals who don’t have access to health insurance (about half of the nations uninsured) over the next decade. Obviously, those who have more to cover will have to spend more. Regardless of what a state spends, the Federal Government covers 93% of the States’ costs. State spending increases are relatively small compared to what States would pay without ObamaCare or to the 26% increase that the federal government will pay towards Medicaid.

More ObamaCare Medicaid Expansion Facts

Here are some detailed facts on Medicaid expansion:

• The federal government will pay a very high share of new Medicaid costs in all states. 100% of costs are covered for the first year. 90% of the spending is done by federal government moving forward.

•Increases in state spending are small compared to increases in coverage and federal revenues, and relative to what states would have spent if reform had not been enacted.

• ObamaCare Medicaid Expansion sets the eligibility level for Medicaid at 133% FLP, although there is a special deduction to income equal to five percentage points of the poverty level raising the effective eligibility level to 138% of poverty.

• The legislation maintains existing income counting rules for the elderly and groups eligible through another program like foster care, low-income Medicare beneficiaries and Supplemental Security Income (SSI).

• The NFIB helped to change the Affordable Care Act to include a “state opt-out” for Medicaid Expansion.

• In combination with ObamaCare’s other provisions, if all states participate in Medicaid expansion, it would reduce the number of uninsured by 48%, relative to the number of uninsured without the ObamaCare. States with higher uninsured rates prior to the ObamaCare would see larger increases in Medicaid and bigger reductions in the uninsured, compared to states with lower pre-ObamaCare uninsured rates.

• If all states implement the expansion, an additional 21.3 million individuals could gain Medicaid coverage by 2022, a 41% increase compared to Medicaid without the ObamaCare. With many States opting out, the number is expected to fall below 15 million.

• Medicaid Expansion covers those who are most likely to use emergency services that cost hospitals tens of billions in unpaid hospital bills.

• States will spend little to nothing expanding Medicaid. For example, it would cost the State of Florida about $5 a year per person to cover all uninsured below the 138% FLP.

• Low-income families and other Americans who would be eligible for Medicaid will fall between the cracks without expansion (as they do now). ObamaCare will most likely have to insure them in the ObamaCare health exchanges. This is projected to drive up the cost of insurance for all Americans by a great deal.

•Big Business-backed groups like ALEC and the NFIB frequently suggest legislation that seeks to dismantle public programs at a state level. They tend to achieve this in Red states where they have the most pull. These states need Medicaid the most as they have the most low-income individuals falling through the cracks. They will also put a bigger burden on everyone else as it will cost more to insure their poorest on the marketplaces.

• If Medicaid Expansion is Opted-out of by too many states, it will greatly diminish the effectiveness and affordability of ObamaCare. Stop your state from Opting out of Medicaid by helping to share the ObamaCare Facts.

• The federal government will pay for most (90% – 100%) of the Medicaid expansion when it is implemented in 2014, but states would be required to pay for up to 10% percent of it by 2020.

• Some States, are saying that paying 0% – 10% of the Medicaid expansion as laid out under ObamaCare will cost them too much. While some States will pay more, the increase is very small (3% average increase in Medicaid Spending), even for the States who will pay the most. Keep in mind emergency room visits cost the State tax payer millions, while the burden of Medicaid is split between the Federal Government and the State. Therefore most State’s would save money over the first 3 years of expansion at the least.

• A Harvard case study found that states who had expanded their Medicaid programs from 2000 to 2005 improved health care for the State and saved thousands of lives.

• Some States are expected to save Billions from ObamaCare’s Medicaid Expansion.

Who Rejected Medicaid Expansion?

Many of the State’s that reject Medicaid Expansion are those who need it the most. Uninsured rates tend to be higher in “red states”. In Texas for example 25% of it’s population is uninsured, Texas opt-ed out of Medicaid Expansion and creating a health insurance marketplace.

Which States Expanded Medicaid under Medicaid Expansion?

Want to know which states will insure the 15 million Americans below the poverty line and which States will leave the rest of the 21.3 million uninsured behind? Find out which states support their state’s poorest. Want more information on ObamaCare and Medicaid Expansion? Get the Full KKF Medicaid Expansion Report.

This list is kept up to date, however which states expand Medicaid is subject to change. Even if you are not eligible for Medicaid you may be able to get very low cost health insurance through your state’s health insurance marketplace due to cost assistance subsidies.

Update: PA initially rejected but decided to move forward with expansion in August of 2014. Expansion (Healthy PA Private Coverage Option) should begin in PA as soon as December, 2015. Pennsylvania proved that we still have hope to see expansion in more states. Please note other states have started moving forward with expansion. We will update this list as they officially start expansion.

NOT PARTICIPATING (24 states)

Alabama*: Gov. Robert Bentley (R)

Alaska*: Gov. Sean Parnell (R)

Florida*: Gov. Rick Scott (R)

Georgia*: Gov. Nathan Deal (R)

Idaho*: Gov. C.L. Otter (R)

Indiana: Gov. Mike Pence (R)

Kansas: Gov. Sam Brownback (R)

Louisiana*: Gov. Bobby Jindal (R)

Maine*: Gov. Paul LePage (R)

Mississippi*:Gov. Phil Bryant (R) – Currently Steve Bullock (D) who supports expansion, although it hasn’t been enacted by the state.

The Cost Of Medicaid Expansion

While states like Florida and Colorado say that a 3% increase in spending is too much, states like Michigan are showing that the States can actually save money by adopting the Medicaid expansion.

The nonprofit Center for Healthcare Research & Transformation projected the net costs of Michigan expanding Medicaid under the health system reform law. In all three scenarios of enrollment uptake assumed by the researchers, the state would reduce both overall spending and the numbers of uninsured residents. Figures represent the state’s 10-year cost savings, in millions, under moderate projections for the enrollment of newly Medicaid-eligible residents in 2014, the expansion’s first year.

Protect The Expansion of Medicaid at a State Level

ObamaCare’s Medicaid expansion, if it moves forward in all 50 states, will help half of the nations uninsured get access to health care. If we don’t support Medicaid Expansion on a state level our nations poorest will go without healthcare. Although many State’s have already decided to opt out of Expansion it is not too late to show your support. If you believe in health care reform, support Obamacare’s Medicaid Expansion in your state.